low O₂ in the blood

low O₂ in the tissues

difficulty breathing while laying down.  relieved by sitting up or standing

hypoxemia

hypoxia

orthopnea

15-30mL

you need deep bronchial secretion

Bronchodialators - Ventolin

Expectorant - Guaifenesin

Antitussive - Codine

glucocorticoids (decrease inflammation) - Prednisone, Solumedrol

mucolytics - mucinex

mast cell inhibitors - singular

• Tumor (size)
• Nodes (are lymph nodes affected?)
• Metastasis (spreading)
• Differentiation (how diff. does the tissue look from the norm?)

What are the signs and symptoms of :

Cancer - throat or larynx

• deep breathing to prevent Atelectisis & Pnemonia
• coughing
• incentive spirometer q every h while awake
• increase fluids 2-3L (assess risk for fluid vol. excess)
• turning & positioning
• Ambulation *best thing to prevent complications
• Assessing affect of O₂ therapy
• Suctioning

• oral antihistamines
• allergy control eye drops
• decondgestants
• steroid nasal sprays and inhalers
• desensitization therapy
• special filtering systems/air conditioning
• limiting exp. to offending agents
• antibiotics if secondary infect. occurs

• children
• urban, low income areas
• some minorities
• allergic indiv.
• people with genetic disposition

coughing

wheezing

shortness of breath

chest tightness

• mold
• dust mites
• weather change
• exercise
• pollen
• cockaroaches
• animal dander 
• second hand smoke

Asthma Medications

(Daily: Long-term Control)

•  -corticosteroids(inhaled and systemic)
• -cromolyn/nedocromil
• -long-acting beta₂-antagonists
• -Methylxanthines
• -Leukotriene modifiers

Asthma Medications

(As-needed: Quick Relief)

-Short-acting beta₂-antagonists

-anticholinergics

-systemic corticosteroids

-Metered-dose inhaler

-Dry powder inhaler

-spacer/holding chamber

-spacer/holding chamber and face mask

-nebulizer

• infections
• Rhinitis
• Sinusitis
• Pharyngitis
• Tonsillitis and adenoiditis
• Peritonisillar abscess
• Laryngitis

TRIPS = tonsilitis, rhinitis, laryngitis, pharyngitis, sinitis 

Tonsilitis and Pharyngitis

viral or bacterial or both?

What would you treat if it were viral?

What is is called when it is bacterial? treatment?

Can be viral or bacterial

treat symptoms (rest, fluids, tylenol, anesthetic lozenges and gargling with warm saline)

Strep- treat with antiboitic.  Pen V or erythromycin commonly used

• interventions to maintain patent airway
• Promote comfort: analgesics, gargles for sore throat, hot packs for sinus congestion or ice collar to reduce swelling
• rest
• refrain from speaking, use alt. communication
• ENCOURAGE LIQUIDS; 2-3L a day and approp. foods

• Topical vasoconstrictors: Adrenaline, Cocaine, Phenylephrine
• Packing of the nasal cavity or balloon catheter
• Silver nitrate applicator and GElfoam or by electrocautery

• hoarseness
• persistent cough
• sore throat or pain and burning in throat
• lump in the neck
• LATER symptoms: dysphagia, dyspnea, unilateral nasal obstruction, persistent hoarseness, persistant ulceration, foul breath
• Generalized symptoms: weight loss, debilitation, lymphadenopathy, and radiation of pain to the ear

• Pulmonary bronchial constriction
• Pneumothorax
• Possible foreign body
• Pulmonary embolus
• Pnemonia
• Pump failure

1. Normal breathing at 12-18 breaths/minute
2. slower than normal rate (<10 breaths/min), w/normal depth and regular rhythm
3. Rapid, shallow breathing >24 breaths/minute
4. Shallow, irregular breathing
5. Increased rate and depth of breathing
6. Period of cessation of breating. Life threatening if sustained
7. Regular cycle where the rate and depth of breathing increase, then decrease until apnea (usually a/b 20 secs) occurs
8. Periods of normal breathing (3-4 breaths) followed by a varying period of apnea (usually 10 seconds to 1 minute)

1. Eupnea
2. Bradypnea
3. Tachypnea
4. Hypoventilation
5. Hyperventilation
6. Apnea
7. Cheyne-Stokes
8. Biot's respiration

EARLY

• restlessness
• tachycardia
• tachypnea
• dyspnea
• ^ agitation
• anxiety
• diaphyoresis
• retractions
• headache 

LATE

• ^restlessness
• stupor
• dyspnea
• Decreased respirations
• bradycardia
• cyanosis 

ABG's

Pulmonary function

Hemoglobin & Hematocrit

History

Pulse Ox less than 90%

• Acute Bronchitis
• Pneumonia: Bacterial, Viral, Aspiration
• Tuberculosis
• ARDS
• Lung Cancer
• Chest Trauma
• Emphysema
• Asthma

Chronic Bronchitis Signs and symptoms

"Blue Bloater"

• color dusky to cyanotic
• recurrent cough & sputum production
• hypoxia
• hypercapnia
• acidosis
• edematous
• Increased resp rate
• exertional dyspnea
• digital clubbing
• Cardiac enlargement
• use of accessory muscles to breathe
• cor pulmonale (late in disease)

Pulmonary Emphysema Signs and Symptoms

"Pink Puffer"

• Increased CO₂ retention (pink)
• no cyanosis
• pursed lip breathing
• dyspnea
• ineffective cough
• hyperresonance on chest percussion
• orthopneic
• barrel chest
• exertional dyspnea
• prolonged expiratory time
• speaks in short herky sentences
• anxious
• use of accessory muscles to breathe
• thin appearance
• leads to right sided <3 failure

• Risk reduction - smoking cessation
• Bronchodilators (relax constricted airways and help relieve the portion of airway obstruction that is reversible)
• corticosteroids (reduce inflammation and inflammatory response in bronchial walls; used for symptomatic relief and preventive care of asthma
• Antibiotics (prevent or treat respiratory infections that commonly develop with COPD as a result of alteration in the normal respiratory defense mechanisms and decreased immune resistance
• Expectorants (facilitate the removal of thick mucous from the airways by liquifying secretions)
• Mast cell stabilizers (prevent the release of bronchoconstrictive and inflammatory substances when mast cells are confronted with allergens and other stimuli, thus helping to prevent asthma attacks)
• influenza and pneumococcal vaccination
• oxygenation therapy

• hypersensitivity
• increased occurence in males
• onset before 12 years
• retractions
• Hypoxemia: tachycardia, ^restlessness, tachypnea
• Familial
• cough
• increased mucous
• shortness of breath
• expiratory wheeze
• ^ CO₂ retention
• prolonged expiration